Healthcare Provider Details

I. General information

NPI: 1871576736
Provider Name (Legal Business Name): KUTAIBA S CHALEBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 KIDSPEACE DR
OREFIELD PA
18069-2044
US

IV. Provider business mailing address

4085 INDEPENDENCE DR
SCHNECKSVILLE PA
18078-2574
US

V. Phone/Fax

Practice location:
  • Phone: 610-799-8477
  • Fax:
Mailing address:
  • Phone: 610-799-8853
  • Fax: 610-799-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD044739L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: